Sudan Nutrition Sector Bulletin Issue No 1 | August 2015 KEY FACTS 1.5 million people targeted for Nutrition as- sistance in 2015 643,075 people received emergency Nu- trition assistance as of 30 July 2015 $95 million HRP appeal for the emer- gency Nutrition response in 2015 29% received of the HRP appeal as of 30 August 2015 $28 million required for critical priori- ty life saving activities up to the end of 2015 Between January and July 2015 Nutrition sector partners have reached 643,075 children, pregnant and lactating women (PLW) through emergency life saving and preventive nutrition interventions. This is 43 per cent of the Humanitarian Response Plan (HRP) 2015 target. As of the end of August 2015 the Nutrition sector had received only 29% of the total funding requirement this year. The sector urgently requires an additional USD $28 million to ensure the continuity of ongoing nutrition interventions and to scale-up critical life-saving activities till the end of 2015. The Community Based Management of Acute Malnutrition (CMAM) scale-up in Sudan is well underway under the collaborative efforts of the Ministry of Health led National Nutrition programme partnering with UNICEF, WFP, WHO as well as national and international NGOs. Since January training on CMAM protocol has been given to 117 master trainers, 335 supervisory level health workers and 748 service provider health workers across the country. As a result of the scale-up the number of functional facilities have reached 943 for outpatient therapeutic programmes and 356 for targeted supplementary feeding. The Ministry of Health (MoH) has allocated SDG 50 million (over USD 8 million) for the procurement of Ready to Use Therapeutic Food (RUTF) and medication for the CMAM scale-up in states with a higher case- load of severe acute malnutrition that have not been prioritised for humanitarian response. In May 2015 the MoH endorsed the long awaited National Strategy for Infant and Young Child Feeding (IYCF). This strategy provides clear guidance on comprehensive and holistic approaches for promoting, protecting and supporting optimum IYCF practices through eight strategies, with a community-IYCF focus. Unless resources are made available, the survival and well being of 290,000 children under five with acute malnutrition, in the most critical localities, will be threatened. 116 SCs 943 OTPs 356 TSFPs 462 IYCF Number of cur- rently open programmes 80,246 Children admitted to SC/OTP in 2015 668,778 Children screened for Acute Malnutri- tion in 2015 133,075 PLW & caretakers participated in IYCF coun- selling this year 250,000 2015 target 653,000 2015 target In this issue... Emergency Nutrition Re- sponse Update: Progress on HRP 2015 pg. 2 CMAM Scale-up in Sudan pg. 3 Sudan IYCF strategy en- dorsement and roll out pg. 4 Joint Resilience Project: A multi-sector approach to tackling malnutrition in Kassala State pg. 4 Success story from the field pg. 5 Upcoming Events pg. 5 Key contacts and About Us pg. 6 73,945 Children under 5 & PLW admitted to TSFP in 2015 319,000 2015 target SECTOR HIGHLIGHTS + Health worker takes MUAC measurement from young child in Nutrition centre in Kassala State
Transcript
Sudan Nutrition Sector Bulletin Issue No 1 | August 2015
KEY FACTS
1.5 million people targeted for Nutrition as-
sistance in 2015
643,075 people
received emergency Nu-
trition assistance as of 30
July 2015
$95 million
HRP appeal for the emer-
gency Nutrition response
in 2015
29% received of the HRP appeal as of
30 August 2015
$28 million
required for critical priori-
ty life saving activities up
to the end of 2015
Between January and July 2015 Nutrition sector partners have reached 643,075 children, pregnant and
lactating women (PLW) through emergency life saving and preventive nutrition interventions. This is 43
per cent of the Humanitarian Response Plan (HRP) 2015 target.
As of the end of August 2015 the Nutrition sector had received only 29% of the total funding requirement
this year. The sector urgently requires an additional USD $28 million to ensure the continuity of ongoing
nutrition interventions and to scale-up critical life-saving activities till the end of 2015.
The Community Based Management of Acute Malnutrition (CMAM) scale-up in Sudan is well underway
under the collaborative efforts of the Ministry of Health led National Nutrition programme partnering with
UNICEF, WFP, WHO as well as national and international NGOs. Since January training on CMAM protocol
has been given to 117 master trainers, 335 supervisory level health workers and 748 service provider
health workers across the country. As a result of the scale-up the number of functional facilities have
reached 943 for outpatient therapeutic programmes and 356 for targeted supplementary feeding.
The Ministry of Health (MoH) has allocated SDG 50 million (over USD 8 million) for the procurement of
Ready to Use Therapeutic Food (RUTF) and medication for the CMAM scale-up in states with a higher case-
load of severe acute malnutrition that have not been prioritised for humanitarian response.
In May 2015 the MoH endorsed the long awaited National Strategy for Infant and Young Child Feeding
(IYCF). This strategy provides clear guidance on comprehensive and holistic approaches for promoting,
protecting and supporting optimum IYCF practices through eight strategies, with a community-IYCF focus.
Unless resources are made available, the survival and well being of 290,000 children under five with acute
malnutrition, in the most critical localities, will be threatened.
116 SCs
943 OTPs
356 TSFPs
462 IYCF
Number of cur-rently open
programmes
80,246 Children
admitted to
SC/OTP in 2015
668,778 Children
screened for
Acute Malnutri-
tion in 2015
133,075 PLW & caretakers
participated in IYCF coun-
selling this year
250,000 2015 target
653,000 2015 target
In this issue...
Emergency Nutrition Re-
sponse Update: Progress
on HRP 2015
pg. 2
CMAM Scale-up in Sudan pg. 3
Sudan IYCF strategy en-
dorsement and roll out
pg. 4
Joint Resilience Project: A
multi-sector approach to
tackling malnutrition in
Kassala State
pg. 4
Success story from the
field
pg. 5
Upcoming Events pg. 5
Key contacts and About
Us
pg. 6
73,945 Children under 5
& PLW admitted
to TSFP in 2015
319,000 2015 target
SECTOR HIGHLIGHTS
+
Health worker takes MUAC measurement from young child in Nutrition centre in Kassala State
Sudan Nutrition Sector Bulletin Page 2
Sudan Emergency Nutrition Response Update : Progress on HRP 2015
The 2015 Nutrition Sector Strategic Response Plan is comprised of inter-
ventions aimed at saving lives and preventing a deterioration in the nu-
trition status of vulnerable children under five, as well as pregnant and
lactating women in critical priority localities of Sudan.
Up to the end of July 2015, 80,246 children with severe acute malnutri-
tion (SAM) have been admitted to outpatient therapeutic programmes
(OTP) across the country. This is an increase in the rate of admission this
year compared to 76,941 and 64,733 SAM admissions during the same
period in 2014 and 2013 respectively (see Chart 1: National SAM admis-
sion trends). This increase is attributable to the implementation of the
CMAM expansion plan, with 943 treatment facilities now serving severe-
ly malnourished children, compared to 795 in December 2014 serving an
additional 15,500 children since 2013. In 2015 overall SAM treatment
performance has met the acceptable levels set by the Sphere minimum
standards. The cure rate is 85.5%, the death rate is 0.8% and the default-
er rate is 0.7%.
Through the Targeted supplementary feeding programme 73,945 acutely
malnourished people comprising 57,524 children under five, and 16,421
pregnant and lactating women (PLW) with moderate acute malnutrition
(MAM) have been admitted for treatment between January and July this
year. Specialised supplementary nutritious food has been provided to a
total of 51,494 nutritionally at risk children 6-36 months, and 20,853
PLW. Mothers of children under three years old also received key aware-
ness messages and counseling on appropriate infant and young child
feeding practices. The provision of supplementary food coupled with
tailored awareness sessions on appropriate feeding prevents deteriora-
tion of nutritional status among children from 6 - 36 months in popula-
tions with a critical level of acute malnutrition. Micronutrient supple-
mentation for children, pregnant and lactating women has also been an
integral part of the nutrition response. Since January 2015 vitamin A
supplementation has been provided to 97,419 children under five years
across the country. A total of 125,110 pregnant women also received
iron folate supplementation during the same period.
In addition to ongoing responses to pre-existing crises, nutrition sector part-
ners have been responding to the needs of newly displaced populations in
the Darfur states. According to OCHA, about 210,000 people (verified and
unverified) have been displaced in Darfur due to insecurity since the
beginning of this year. Among the displaced population, a total of
19,733 children and pregnant and lactating women received nutrition
assistance. Amongst the displaced population 22,000 children under five
and PLW’s still require nutrition assistance.
Overall, since the beginning of 2015 nutrition sector partners have
reached 643,075 children and pregnant and lactating women through
emergency life saving and preventative nutrition interventions. This is
43% of the HRP 2015 Nutrition response target (see Figure 1). The Nu-
trition sector achievements to date in reaching the targeted beneficiaries
for the year is on par with the funding received during the first half of the
year. As of the end of July, the Nutrition sector had only received 29% of
the total requirement.
The nutrition sector requires an additional USD $28 million to ensure the
continuity of ongoing nutrition interventions, and to scale up critical life-
saving activities till the end of 2015. Unless resources are made available,
the survival and well being of 290,000 children under five with acute
malnutrition, in the most critical localities, will be threatened. Acute mal-
nutrition, specifically severe acute malnutrition, is a life-threatening con-
dition. According to the WHO, if left untreated, severe acute malnutrition
results in a 30-50% mortality rate among affected children.
0
2000
4000
6000
8000
10000
12000
14000
16000
j f m a m j j a s o n d
National SAM admissions
2010 2011 2012 2013 2014 2015
102,009
76,120
47,659
122,919
80,246
136,838
Chart 1: National SAM admission Trend
Fig 1: Total Targeted and Reached by Nutrition sector partners ,January - July,2015
250,000 279,000
40,000 74,000
46,000
60,932
881,876
250,000
653,000
80,246 57,524
16,421
51,494 20,853
60,932
97,419
125,110
133,076
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Treatment of SAM TaragatedSupplemntary
Feeding U5
TargatedSupplementry PLW
MAM PreventionU2
MAM PreventionPLW
BlanketSuppmentary
Feeding Program(BSFP)
Vitamin Asupplemntion U5
Iron and Folic Acidsupplemntation
Infant and YoungChild Feeding
Practices (IYCF)
TOTAL PEOPLE REACHED BY NUTRITION SECTOR JANUARY - JULY ,2015
Community Based Management of Acute Malnutrition Scale-Up in Sudan
The Sudan National S3M survey undertaken in 2013 indicated a total of
54 of 184 localities with an acute malnutrition prevalence above the
emergency threshold of 15%. Meanwhile, the capacity to treat severe
and moderate acute malnutrition remains relatively low, and focused
only on states with complex emergencies. Only a quarter of the SAM bur-
den (136,838 children) was reached through CMAM in 2014. This
prompted the Ministry of Health and partners to look into ways of scal-
ing up CMAM to obtain a sustained high coverage rate for treatment of
severe acute malnutrition, both in high prevalence, as well as high bur-
den, localities.
Following these results, the CMAM scale-up plan was developed indicat-
ing key targets and geographical areas for acceleration in the coming
three years until the end of 2017. The plan considered stabilisation cen-
tres, OTPs and MAM management, as well as community mobilisation.
State level planning workshops took place in each of the eighteen states
of Sudan in which locality teams reviewed and identified priority loca-
tions and facilities for scale-up based on available information. Several
consultations followed, including a discussion in a meeting between the
nutrition directors. As a result the CMAM scale-up plan has been summa-
rised into a national plan with clear targets and a monitoring and evalua-
tion framework.
The major achievements include:
Making supplies available for CMAM: UNICEF (for SAM) and WFP
(for MAM) continue to mobilise resources to reach malnourished chil-
dren in areas prioritised for humanitarian assistance. However, gaps
remain in areas where there is a high burden amongst a high population
density, although the relative prevalence may be less than the localities
affected by complex emergencies. For the first time, the MoH has decided
to allocate over SDG 50 million (over USD 8 million) for ready-to-use
therapeutic food (RUTF) and routine drugs in order to increase the num-
ber of children receiving treatment for SAM and to cover the gaps in ex-
isting resources from humanitarian partners. Hence, 2015 has seen im-
proved availability of CMAM supplies to allow an increased number of
children to be treated. Between January and May, UNICEF dispatched
75,291 cartons of RUTF, and plans to distribute a total of 200,000 car-
tons in 2015. Similarly, WFP is working on ensuring uninterrupted
availability of MAM supplies.
Making skilled human resources available: In accordance with the
CMAM evaluation recommendations, a simplified operational guide has
been developed together with training materials which have been trans-
lated into Arabic. The
guide has been de-
signed in such a way
that it will also be
used as pocket refer-
ence to treat uncom-
plicated cases of SAM
and MAM at the com-
munity level. Be-
tween February and
June 2015, a total of
117 master trainers
were trained. These
master trainers have
since returned to their respective states and trained an additional 335
health workers (service provider trainers) across ten states. Service pro-
vider trainings are currently underway at the locality and facility level.
So far 748 have been trained.
Physical accessibility of services: Only 12.8% of functional health
units are providing nutrition services, showing the immense opportunity
for integration. It is important to note that the referred nutrition service
is mostly growth monitoring and not CMAM. The CMAM scale-up plan
emphasises and builds upon using existing health facilities whenever
possible. As a result of the scale-up the number of functional OTPs has
reached 943 while 356 SFP sites are providing MAM treatment.
Community mobilisation (for initial, and continued, utilisation of
services): A community mobilisation strategy has been developed
and tested in two states. It uses the existing health and administrative
systems. Community engagement will be ensured by integrating the
health facility and the popular committee at the community level. Les-
sons from supervisory visits and coverage assessments will be drawn
upon to improve services and keep children in the programme until re-
covery.
Ensuring quality of care: Targeted support is required to ensure
quality of care is maintained with performance indicators above the
Sphere standards. This will be achieved through a joint mentoring ap-
proach where experienced nutritionists will move between localities
training facilities using a standardised score card. The MoH and UNICEF
are finalising preparatory work for selection and deployment through
NGOs. This will allow for maximum time spent in the field supporting
health workers. WFP is also exploring a revision of the TOR of food mon-
itors with appropriate health or nutrition backgrounds for participation
in mentoring activities.
A group of women feed their children plumpy nut , while
waiting for further assessments in a nutrition centre in
Kassala state.,2014
Fig :3 :
Fig :4 :
Sudan Nutrition Sector Bulletin Page 4
Sudan Infant and Young Child Feeding Strategy Endorsement and Roll Out
Over the past decade, Kassala State has been exposed to regular floods and periods of drought that have negatively impacted livelihoods and community coping mechanisms, exacerbating food insecurity and mal-nutrition. A baseline survey conducted in 2014 showed a very critical level stunting rate of 67% among children aged 6-59 months in Kassala State
The joint resilience project is a three year (2014-2017) DFID funded project fostering a partnership between UNICEF, FAO and WFP. The project adopts a coordinated, holistic approach to increase community resilience by addressing the effects of shocks, such as floods and droughts, on the health and nutrition status of women and children. It is targeting four localities in Kassala State, in the eastern part of Sudan, namely Hamashkoreib, North Delta, Rural Aroma and Telkuk.
A total of GBP 14.2 million (USD 22.7 million) is budgeted for the pro-ject, out of which GBP 13.3 million (USD 21.3 million) was funded by DFID.
A set of high impact and cost effective interventions will be implement-ed that seek to improve and strengthen community and household level resilience whilst addressing the burden of malnutrition. The project employs a coordinated and a holistic approach to combat malnutrition in a comprehensive manner.
The main actions in the project focus on:
Empowering communities to set their own priority actions to ad-dress the effects of floods and drought, leading to community own-ership.
Improving the nutritional status of women and children.
Improving sanitation and hygiene practices.
Improving food availability, diet diversity and expanding opportuni-ties for income and asset generation.
It is a well established fact that malnutrition is associated with a myri-
ad of factors that include inadequate intake of nutrients, disease, inade-
quate access to portable water and preventive health services, poor
child care, poor hygiene and sanitation practices, and household food
insecurity. Efforts aimed at addressing the burden of malnutrition
should be based on a multi-sectoral approach. In this regard, the joint
resilience project, which has been operational in Kassala state since
2014, forms a notable example that could be replicated in other states,
based on lessons learned and the best practices.
The Sudan Infant and Young Child Feeding (IYCF) National strategy was
endorsed and rolled-out in May 2015. It provides a framework to guide,
in a comprehensive and accelerated manner, actions aimed at improv-
ing IYCF practices and services in Sudan. The overall goal of the strate-
gy is to improve, through optimal feeding, the nutritional status,
growth, development, health, and thus the survival, of infants and
young children. The specific objectives are 1) To create a supportive
environment, including political commitments, multi-sectoral coordina-
tion between the government, international organisations and other
stakeholders, for optimal feeding practices of infants and young chil-
dren. 2) To build capacity and increase the knowledge/skills of health
workers in providing pregnant women and lactating mothers with sup-
port to improve optimal IYCF practices as part of a basic health pack-
age. 3) To equip communities and households with the knowledge,
capacity and skills needed to support pregnant women and lactating
mothers in practicing optimal IYCF practices among their communities
and households.
Following the endorsement of the IYCF strategy, a plan of action for the
roll out of the strategy in communities was developed. The IYCF strate-
gy involves training for community structures (including the MoH,
women's unions, popular committees and other community initiatives),
starting with a master training, followed by ToT trainings for the state
community structures, and concluding with a training of groups of
mothers at the locality and village levels. The first round of trainings
targeted 30 master trainers. In the coming months state level Training
of Trainers (TOT) will be provided to 300 health workers and will be
followed by 7,500 mother support groups members.
Team photo during the C-IYCF counselling master training at federal level,
Joint Resilience Project : A multi-Sector approach to tackling malnutrition
Community consultation with a group of men in Shabash (North Delta), Kassala sate
